P.O. Box 934, Olney, MD 20830 [email protected] www.projectchange-md.org 301-257-4769 2015 STUDENT LEADERSHIP INSTITUTE Rising Sixth through Eighth Graders Session 1 - July 13-17 Session 2 - July 20-24 St. John’s Episcopal School, 3427 Olney Laytonsville Road, Olney, MD 20832 Student’s Name ________________________________________________________ Address ______________________________________________________________ ______________________________________________________________ Parent/Guardian’s Name__________________________________________________ Phone_________________________________________________________________ Email _________________________________________________________________ School student will be attending fall 2015 ____________________________________ Grade in fall 2015 _______ Male _____ Female _____ How many Student Service Learning (SSL) hours has student completed? __________ Has student previously attended the Student Leadership Institute? ___________ Student is registering for (select one): Session 1 (July 13-17) ______ Session 2 (July 20-24) ______ Application Deadline: June 17 Fee: $125 if submitted by May 31; $150 if submitted between June 1 and June 17. Pay online: www.projectchange-md.org. Go to “Donate” page and click on Student Leadership Institute in down menu. Pay by mail: Enclose a check payable to “Project Change” and mail to: P.O. Box 934, Olney, MD 20830. Please check box if you request limited need-based (50%) scholarship funds. First come first served basis. Submit application without payment. Project Change will contact you.
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